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INTERGRATED STUDIES IN MENTAL HEALTH > schizophrenia > Flashcards

schizophrenia Flashcards

1
Q

what is schizophrenia (scz)

A

Oscillation between normal and abnormal sense of reality and sense of reality

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2
Q

What is Scz characterized by

A

Loss of contact with reality
Disruption of thought
-Perception
-Mood
-Movement

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3
Q

what is Epidemiology of Schizophrenia and what is it linked to?

A

1/100 lifetime risk in the general population.

Signs show at around the age of 15-25(Men): This is when the prefrontal cortex usually develops.

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4
Q

What are is the meaning of positive and negative symptoms

A

Positive: presence of symptoms that are not normally there

Negative: Absence of normal symptoms

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5
Q

List some of the negative symptoms of SCZ

A

Reduced expression of emotion

Poverty of speech

Difficulty in initiating goal-directed movements

Cognitive/Memory impairment

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6
Q

What are the subtypes of SCZ

A

1.Paranoid schizophrenia

  1. Disorganised

3.Cationic: agitated, purposeless movement

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7
Q

what is Paranoid schizophrenia

A

Delusion and hallucination
-thought disorder, disorganized behaviour, and mood flattening are absent

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8
Q

what is disorganised schizophrenia

A

thought disorder and mood flattening

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9
Q

what is catatonic schizophrenia

A

Rare scz disorder. Symptoms can involve flipping between hyperactivity and under activity

> underactivity : significant reductions in voluntary movement

> hyperactivity: agitated, purposeless movement, exhibit unusual styles and levels of physical movement

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10
Q

What are the causes of SCZ

A

Environmental factors

Genetics

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11
Q

What are the environmental factors that can lead to SCZ

A

Social stress
-especially early in life (Post or pre natal)

Prenatal infection and famine

Obstetric and perinatal complications

Older paternal age

Cannabis use/ substance misuse

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12
Q

What are the pathophysiological theories of Schizophrenia

A

1.Dopamine hypothesis

2.Glutamate hypothesis

3.GABA hypothesis

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13
Q

What is the Dopamine hypothesis

A

That excess dopaminergic NTission in mesolimbic and striatal brain region results in schizophrenic symptoms

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14
Q

What is the evidence behind the dopamine theory

A
  1. Most antipsychotics block D2 receptors
  2. Drugs that increase dopaminergic activity aggravate or produce sycosis
  3. D receptor numbers increase in post-mortem brain of schizophrenics

4.Increase D receptor density

5.Successful treatment changed levels of homovanillic acid (dopamine metabolite)

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15
Q

What the evidence against the dopamine hypothesis

A

Antipsychotic drugs only partially effective for most patients

NMDA receptor (glutamate receptor) antagonists (phencyclidine) more potent

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16
Q

What is the glutamatergic hypothesis of schizophrenia

A

NMDA receptor antagonist are potent dopamine releasers

-This caused psychotic symptoms in a health human and exacerbation in patients

The treatment of SCZ with D-serine, glycine and sarcosine (NMDA receptor modulators) have therapeutic benefits in negative symptoms

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17
Q

What is the GABAergic hypothesis of SCZ

A

Decrease in GABA leads to enhanced DA neuron activation there for more DA release

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18
Q

what are the main targets of antipsychotic drugs

A

Dopamine receptor and serotonin receptor

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19
Q

What are the positive symptoms of SCZ

A

Delusions
Hallucinations
Disorganised speech
Grossly disorganized or catatonic behaviour

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20
Q

What is the brain regions and systems included in the dopamine hypothesis for schizophrenia

A

Substantial nigra

VTA

Tuberohypohyseal systems

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21
Q

What is the proposed mechanism of the glutaminergic hypothesis

A

Hypofunction of NMDA receptors on GABAergic interneuron

Leads to less inhibition of principal glutaminergic cells

Activates dopamine expressing cells

More dopamine release

22
Q

What is the mechanism of the GABAergic synthesis

A

Deficiency in signalling in the TrkB neurotrophin receptors leads to reduced GABA synthesis in Parvalbumin-containing GABA neurons

– enhanced excitability of the pyramidal neurons in dorsal PFC

–Enhanced activation of DA neurons

23
Q

which dopamine receptors does not have a role in psychosis

A

D1 receptos

24
Q

What are the main dopamine pathways

A

Meso-cortical limbic pathways: Behaviour

-Nigro-striatal pathways: Voluntary movements

-Tuberoinfundibular system: Dopamine released to inhibit prolactin release

-Medullary-periventricular pathway: feeding behaviour

-Incertohypothalamic pathways: Fear conditioning

25
Q

What are the two families of dopamine receptors

A

D1-like: D1 and D5

D2-like: D2,D3 and D4

They are all metabotropic (G-protein)

26
Q

What are the mechanism of D1 and D5 receptors

A

D1: Increase cAMP by Gs-coupled of adenylyl cyclase expressed in the putamen, Nucleus Accumben, olfactory tubercle

27
Q

How to D2 receptors work

A

Decrease cAMP in Gi-Coupled inhibition of adenylyl cyclase
-Inhibit Ca2+ channels: decrease neuronal activity
-Opens K+ channels

28
Q

What is difference between typical and Atypical anti-psychotics

A

-Receptor profile
-Incidence of extra pyramidal side-effects
-Efficacy in ‘treatment-resistance’ groups
-Efficacy against negative symptoms

29
Q

What are the main classes of typical antipsychotics

A

-Phenothiazine class
-Butyrophenone class

30
Q

How many groups of the class phenothiazine are there and list some examples

A

Group 1: chlorpromazine; levomepromazine; promazine

Group 2: pericyazine; pipotiazine

Group 3: Fluphenazine and Prochlorperazine

31
Q

What are the side effects of the Phenothiazine groups

A

Group 1:
-Pronounced sedative effect
-Anti-muscarinic and extrapyramidal side effects
- Hypotensive side effects
-Low clinical potency

Group 2
-Moderate sedative effect
-Severe anti-muscarinic effects
-Pronounced extrapyramidal side effects

Group 3
-Fewer sedative and anti-muscarinic effects
-Pronounced extrapyramidal side effects

32
Q

What are the drugs in group 1 phenothiazines

A

chlorpromazine;

levomepromazine;

promazine

33
Q

What are the drugs in group 2 phenothiazines

A

pericyazine; pipotiazine

34
Q

What are the drugs in group 3 phenothiazines

A

fluphenazine; prochlorperazine

35
Q

What drug is under the class of Butyrophenone

A

Haloperidol

Benperidol

36
Q

List some typical anti-psychotic drugs

A

Clozapine

Risperidone

Aripirazole

37
Q

Properties of Haloperidol

A

Use is limit due to severe (Extra pyramidal symptoms) EPS

-High D2 receptor affinity
-Potent
-Has hypotensive side effects

38
Q

What are the positive properties of Clozapine

A

-Greater affinity to 5-HT than D2
-Potent D4 antagonist
-Efficient in ‘Treatment-resistant’ patient
-No EPS

39
Q

What are the negative symptoms associated with Clozapine

A

Risk of agranulocytosis
Lowers seizure threshold: Easier for seizures to occur
Weight gain
Only licenced for unresponsive patients

40
Q

Properties of Risperidone

A

-Affinty:5-HT2 > D2
-Broad efficacy and more potent than Clozapine
-Little to No EPS, ANS and cardiac S/E at low doses

41
Q

Properties of Aripiprazole

A

-A fairly new drug
-Partial agonist at D2
-limited S/E
-Long 1/2t for better compliance

42
Q

What advantages does 2nd gen have over 1st gen

A

-Little or no EPS
-Treating positive and negative symptoms
-Treatment resistant patients

43
Q

What are some non-psychiatric indications for antipsychotics

A

Anti-emetics:
-In older agents
- Blocks Dopamine receptor centrally and peripherally in the stomach
Sedative
-Blocks H1 receptor (Promethazine)

44
Q

What can Extra pyramidal reactions cause/ side effects

A

-Acute dystonia; Parkinsonian
>Early onset
>Reversible
-Tardive Dyskinesia: Repeated uncontrollable movement
>Late onset
>More serious
>Often irreversible

45
Q

What are the effects of the Autonomic Nervous system effects

A

Anti-Muscarinic effects
>Loss of accommodation
>Dry mouth
>Difficulty urinating
>Constipation
Adreno-receptor blocking effects
>Orthostatic hypotension
>Impotence

46
Q

What are metabolic and endocrine side effects

A

Weight gain

Hyperglycaemia secondary to insulin resistance

Hyperprolactic aemia

47
Q

What are the cardiac side effects of anti-psychotics

A

-Thioridazine: Ventricular arrythmia, cardiac conduction block, sudden death

48
Q

What are the toxic effects of Anti-psychotics

A

Agranulocytosis
Jaundice
Skin eruption

49
Q

What are the Behavioural effects of Anti-psychotics

A

Older agents unpleasant to take

Pseudo depression

Toxic confusional state

50
Q

What affects does smoking have on anti-psychotics

A

Increases the metabolism of the anti-psychotics
-Found in the cigarette not the Tobacco

51
Q

Name some other classes of Anti-psychotics and their drugs.

A

Thioxanthenes: Flupentixol and Zuclopenthixol

Diphenylbutylpiperidines:

INTERGRATED STUDIES IN MENTAL HEALTH (16 decks)

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